Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause significant social, communication and behavioural challenges. This video explores the previous and updated diagnostic criteria for ASD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 2013 was the new edition of this manual published (DSM-5). The DSM-5 redefined the autism spectrum to encompass the previous (DSM-IV-TR) diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder. Autistic individuals are now placed on a continuum depending on the severity of their symptoms.

Neuroscientist Janet K. Kern, PhD, speaks in this video about the connection between thiomersal in vaccines and autism. Thiomersal, commonly known in the U.S. as thimerosal, is an organomercury compound. Dr. Kern gave this talk for the UNEP Intergovernmental Negotiating Committee in Punta del Este, Uruguay, in July, 2012. She is a director of the Council for Nutritional and Environmental Medicine (CONEM), and the chairman of the CONEM US Autism Research Group.

There is growing evidence for a gut-brain connection associated with autism spectrum disorder (ASD), which suggests a potential benefit for digestive enzyme therapy in autistic children (1). Working with an Egyptian team, Geir Bjørklund and collaborators performed a double-blind, randomized clinical trial on 101 children with ASD (82 boys and 19 girls) aged from 3 to 9 years (1). The autistic children were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) diagnostic criteria. Structured interviews of at least one hour were first performed both with the parents and the children. In a later two hours session was the Childhood Autism Rating Scale (CARS) applied. After this, the children with ASD were randomized to receive digestive enzymes or placebo (1). It was found that autistic children that received digestive enzyme therapy for three months had significant improvement in emotional response, general impression autistic score, general behavior, and gastrointestinal symptoms. These results indicate that digestive enzyme therapy in the future may be a possible option in the treatment protocols for ASD (1).

The first author of the article, Khaled Saad, is Associate Professor of Pediatrics at Assiut University, Assiut, Egypt. Geir Bjørklund is the founder and president of the Council for Nutritional and Environmental Medicine (CONEM).

Vitamin D deficiency has been previously reported in patients with autism spectrum disorder (ASD). However, the data on the relationship between vitamin D deficiency and the severity of ASD are limited. In collaboration with Egyptian researchers, Geir Bjørklund (2015) performed a case-controlled cross-sectional analysis on 122 children with ASD, to assess their vitamin D status compared to healthy control children and the relationship between the degree of vitamin D deficiency and the severity of ASD (1).

Fifty-seven percent of the patients with ASD in the study had vitamin D deficiency, and 30% had vitamin D insufficiency. The vitamin D levels in the children with severe ASD were significantly lower than those in children with mild/moderate ASD. It was found that the vitamin D levels had significant negative correlations with the Childhood Autism Rating Scale (CARS) scores (1).

106 children with low serum vitamin D levels (<30 ng/ml) then participated in an open-label trial of vitamin D supplementation. The patients were given 300 IU/kg/day (not to exceed 5000 IU/day) for three months. Eighty-three ASD patients completed three months of daily vitamin D treatment. 80.72% (67/83) of the children with ASD who received vitamin D3 treatment had significantly improved outcome, which was mainly in the sections of the Childhood Autism Rating Scale and aberrant behavior checklist subscales that measure behavior, stereotype, eye contact, and attention span (1). Of the 16 parameters measured, ten showed highly statistically significant improvements (see table below).

Parameter

P Value (* highly statistically significant)

Relating to people

<0.001*

Emotional Response

<0.001*

Imitation

<0.001*

Body use

0.01*

Object use

0.01*

Adaption to change

0.004*

Listening response

0.01*

Taste, smell, touch

0.1

Visual response

0.003*

Fear

0.13

Verbal communication

0.3

Activity level

0.32

Non-verbal communication

0.2

Intellectual response

0.1

General impression

<0.001*

Total CARS score

<.001*

The researchers concluded that as vitamin D is inexpensive, readily available and safe it may have beneficial effects in ASD patients, particularly when the final serum level is more than 40 ng/ml (1). It should be noted that these results were achieved after only three months of vitamin D supplementation. In a condition that is often present at birth and lasts a lifetime, this is a highly significant finding and should be fully explored immediately.

The first author of the study, Khaled Saad, is Associate Professor of Pediatrics at Assiut University, Assiut, Egypt. Geir Bjørklund is founder and president of the Council for Nutritional and Environmental Medicine (CONEM). Also, one of the coauthors is John Cannell, MD. He is the founder of the Vitamin D Council in San Luis Obispo, California, United States. The study is registered in UMIN Clinical Trials Registry: UMIN000016770.

Researchers at Assiut University have in collaboration with Geir Bjørklund evaluated the neuropsychological status in 78 children with early and continuously treated phenylketonuria (PKU) in Assiut, Upper Egypt. The article was on 10 January 2015 published online first in Acta Neurologica Belgica. The first author of the study, Khaled Saad, is Associate Professor of Pediatrics at Assiut University, Assiut, Egypt. Bjørklund is founder and president of the Council for Nutritional and Environmental Medicine (CONEM).

The aim of this study is to evaluate the neuropsychological status in a cohort of children with early and continuously treated phenylketonuria in Assiut, Upper Egypt. The study was implemented in seventy-eight phenylketonuria (PKU) children. Only 34 patients met the inclusion criteria. Investigated patients were evaluated according to detailed history, neurological examination, Childhood Autism Rating Scale, full scale Intelligence Quotient, attention deficit hyperactivity disorder, electroencephalography and magnetic resonance imaging (MRI). This study concluded that the prognosis for early diagnosed children with PKU treated from the first weeks of life is generally good. However, they are at increased risk for neurological complications and behavioral problems. So, neonatal screening for PKU is highly recommended in Egypt, for early detection and management. In addition, neuropsychological and MRI assessments in PKU children should be done.

In collaboration with Chinese researchers, Geir Bjørklund investigated the serum levels of zinc (Zn) and copper (Cu) in 60 Chinese children with autism (48 boys, 12 girls) and a control group of 60 healthy sex-matched and age-matched individuals. The researchers also evaluated the severity of autism using the Childhood Autism Rating Scale (CARS) score. The mean serum Zn levels and Zn/Cu ratio in the study were significantly lower in the autistic children compared with the control group (P<0.001). At the same time were the serum Cu levels significantly higher in the autistic children compared with the control group (P<0.001). It was in the study found a significant negative association between the Zn/Cu ratio and CARS scores (r=-0.345, P=0.007).

Trace elements play a critical role in the pathogenesis of autism spectrum disorders (ASD). The aim of this study was to investigate the serum levels of zinc (Zn) and copper (Cu) in Chinese children with ASD. Sixty patients (48 males, 12 females) diagnosed with ASD and 60 healthy sex-matched and age-matched control participants were assessed for serum Zn and Cu content at admission. The severity of ASD was also evaluated using the Childhood Autism Rating Scale (CARS) score. The results indicated that the mean serum Zn levels and Zn/Cu ratio were significantly lower in children with ASD compared with normal cases (P<0.001, respectively), whereas serum Cu levels were significantly higher (P<0.001). There was a significant negative association between Zn/Cu and CARS scores (r=-0.345, P=0.007). On the basis of the receiver operating characteristic curve, the optimal cut-off value of serum levels of Zn/Cu as an indicator for an auxiliary diagnosis of autism was projected to be 0.665, which yielded a sensitivity of 90.0% and a specificity of 91.7%; the area under the curve was 0.968 (95% confidence interval, 0.943-0.993). In conclusion, these results suggested an association between serum levels of Zn and Cu and ASD among Chinese patients, and the Zn/Cu ratio could be considered a biomarker of ASD.

Liz Lipski, PhD, CCN is academic director of Nutrition & Integrative Health Programs at Maryland University of Integrative Health in Laurel, Maryland. She is author of the books Digestive Wellness, Digestion Connection, and Digestive Wellness for Children. Lipski is also a CONEM member. In this lecture, Dr. Lipski talks about digestive health issues in autism spectrum disorders. Many people on the spectrum have digestive health issues such as irritable bowel syndrome, pain, gas, bloating, diarrhea, constipation, bacterial and/or fungal infections, heartburn and more. This lecture focuses on understanding what problems can occur and offer practical solutions to enhance overall health by balancing digestive issues. This includes testing, special diets, and use of supplements and herbs for common issues. This lecture was held on 13 October 2012 at the Fall 2012 Autism Research Institute Conference in Garden Grove, California.

Boyd E. Haley, Ph.D. is professor emeritus and former chairman of the Department of Chemistry at the University of Kentucky. He is president and CEO of CTI Science, a Lexington, Kentucky-based bio-technology firm. Haley is also a CONEM member. In this lecture, Professor Haley talks about mercury and other heavy metals, and their relationship to neurological illnesses (especially autism) and oxidative stress. The lecture was held in March 2010 at an IAOMT conference in Galloway, New Jersey.

Children with Autism spectrum disorders (ASDs) appear to be at risk for zinc (Zn) deficiency, copper (Cu) toxicity, have often low Zn/Cu ratio, and often disturbed metallothionein (MT) system functioning. The evidence presented in this paper suggests that providing Zn to autistic children may be an important component of a treatment protocol, especially in children with Zn deficiency. It is important to monitor and follow the values for both Cu and Zn together during Zn therapy, because these two trace elements are both antagonists in function, and essential for living cells.

Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. Several studies have suggested a disturbance in the copper (Cu) and zinc (Zn) metabolism in ASDs. Zinc deficiency, excess Cu levels, and low Zn/Cu ratio are common in children diagnosed with an ASD. The literature also suggests that mercury accumulation may occur as a cause or consequence of metallothionein (MT) dysfunction in children diagnosed with an ASD, which may be one of the causes of Zn deficiency. MTs are proteins with important functions in metal metabolism and protection. Zinc and Cu bind to and participate in the control of the synthesis of MT proteins. Studies indicate that the GABAergic system may be involved in ASDs, and that Zn and Cu may play a role in this system.